Hospitals are having to take the brunt of extra patients now that fewer doctors are bulk-billing, Bridie Smith reports.

The writing on the wall of the waiting room at the Northern Hospital in Epping is one to which staff frequently point - its message is clear.

"This is an emergency department (underlined) not a general practice," it reads. "The aim of the department is to see patients with potentially life-threatening (underlined) conditions or injuries."

But still they come. Category four and five patients (those with the least-threatening conditions) now account for more than half of emergency arrivals at Northern.

It is trend that many staff attribute to the drop in bulk-billing rates and the limited hours general practitioners keep. Built six years ago, the Northern Hospital sits in the City of Whittlesea, which has one of the lowest number of GPs per capita in the state.

Savvas Haitidis is waiting in the general practitioner unit to the side of the emergency department. He has a sore right shoulder, which he injured a month ago while playing soccer. He decided to go to the emergency department on Friday because he is on holidays and it was convenient.

"The waiting is twice as long, but you don't mind because you get seen," the 47-year-old carpenter says.

"I decided to come to the hospital (instead of a GP) because hospitals have all the facilities and can refer in the one building," he says.

Mr Haitidis was referred for an ultrasound after his 20-minute consultation. Despite receiving all the services for free, he says this was not a factor in deciding to come to the hospital.

Lying in another corridor, Amanda Marmo, 29, of Thomastown, was admitted mid-afternoon with lower back pain after two attempts at seeing a GP. "My local doctor was closed so I went to the medical centre at Mill Park (at 1pm) and was told the next appointment was at 7.45pm," she says.

Her husband Bryce drove her to the Northern Hospital as a last resort, where she was seen within an hour of arriving.

Northern Hospital emergency admissionsFriday, January 2, 3-7pmCategory 1 (to be seen immediately) - NilCategory 2 (to be seen within 10 minutes) - 1Category 3 (to be seen within half an hour) - 4Category 4 (to be seen within one hour) - 14Category 5 (to be seen within two hours-plus) - 8

(Category four and five patients are considered able to see a general practitioner.)

"It beats waiting," she says. "After four days of back pain, I had had enough."

The service the Northern is offering is making an impression on the community.

"It's becoming quite well known in the community that you don't have to wait when you come to the Northern," says Doreen Power, operations director.

The hospital now has patients arriving with urinary tract infections, constipation and flu symptoms. Some even arrive wanting prescriptions. All are scenarios that GPs should deal with. But the hospital has a policy that does not allow patients to be turned away.

One nurse describes it as the stray cat syndrome. The more you feed it, the more it will come back.

Julia Jawlich and her son Ethan.Picture: Shannon Morris

Another nurse, Ida Thavarajah, says people are usually happy to wait.

"Sometimes it is quicker to see a doctor here than to go to a GP," she says.

"Also, people come here for their blood tests because they will get the results that day."

When the hospital opened, the emergency department processed 38,000 patients. That figure grew to 48,000 last financial year and nurse unit manager Jane Jenkins said it will deal with about 57,000 this year.

In the four hours that The Sunday Age spent in the emergency department on Friday, 27 patients were admitted. Eight were category five but the bulk, 14, were category four.

Much of the increase, Ms Jenkins says, can be attributed to the fall in bulk-billing rates.

In the 2002-2003 financial year, category four and five patients at the Northern Hospital emergency department accounted for 63 per cent of patients. Figures for the year to date show that is now 70 per cent - and category five patients have increased by 10 per cent.

"We have noticed a dramatic increase since July. We have continued to increase the numbers (of emergency admissions) where 180 is now reasonable for us. In the past that would have been considered frantic," Ms Power says.

Patients have no out-of-pocket expenses coming to a public hospital. As well as the consultation costs, if a patient needs to take home pharmacy supplies, X-rays, pathology or scripts, the cost is covered.